Aggressive periodontitis is very rare in contrast to chronic periodontitis. It progresses faster and bone resorption and inflammatory gum pockets with bleeding gums occur rapidly, although oral hygiene is usually adequate or better. In young adults the first permanent molars and front teeth are often affected. With increasing age, the periodontal apparatus of the remaining teeth also becomes diseased, resulting in premature tooth loss.
Causes of aggressive periodontitis
Inadequate oral hygiene usually causes bacterial complexes to migrate from the plaque into the depths and attack the tissue surrounding the tooth and then the bone. The plaque is then called subgingival plaque, which leads to the formation of gum pockets. However, patients with aggressive periodontitis often show an MI ratio between plaque accumulation and degree of destruction.
Although little bacterial plaque is actually visible, the periodontitis has already led to bone resorption. Unfortunately, this is often not immediately noticeable, even during check-ups, because the bone resorption is only visible in the OPG x-ray. Patients with aggressive periodontitis often have a family history of periodontitis.
In addition, a phagocyte abnormality, an interleukin-1 polymorphism or a hyperresponsive macrophage phenotype have been demonstrated as causes in some patients, although the patients are otherwise healthy. Smoking, stress and depression, and hormonal changes may accelerate the progression, but are not triggers of aggressive periodontitis. Aggressive periodontitis is a bacterial infection and the triggers are so-called marker germs.
Marker germs are bacterial complexes that are located in the plaque. There are different complexes with different functions. The germ Aggregatibacter actinomycetemcomitans is often detected in patients with aggressive periodontitis.
It is considered a very harmful leading germ and thus the main cause. The germs involved can be identified by means of a laboratory test, so that a targeted antibiotic therapy can be initiated. You can find detailed information about this under: Aggregatibacter actinomycetemcomitans
Diagnosis of aggressive periodontitis
The diagnosis is made at the dentist when an inspection of the oral cavity is made and the gum pockets are measured. An X-ray of all teeth shows the degradation of bone. In order to be able to make a reliable diagnosis, it is important to document the course of the tissue loss. If increased bone resorption is observed within a short period of time, a test for Aggregatibacter actinomycetetemkomitans can provide clarity. Since aggressive periodontitis is characterized by a conspicuous family history, a family anamnesis should also be performed and, at best, the family members should also be examined.
What are the symptoms of aggressive periodontitis?
Typical symptoms of aggressive periodontitis are the attack of the front teeth and the first permanent molars, as well as the early onset of the disease. It usually affects young people. In contrast to chronic periodontitis, the loss of tissue in aggressive periodontitis occurs much faster.
Gum pockets form and the gums can be very red and swollen. Gum bleeding often occurs, spontaneously or at the slightest touch. Pus formation in the gum pockets leads to an unpleasant taste in the mouth and often to bad breath.
The rapidly progressing inflammation leads to bone loss, which can cause teeth to loosen. The gums recede and exposed necks of teeth are formed, which can also be sensitive to cold. This can lead to a general bad feeling of illness, which in rare cases can also be accompanied by fever.
- Identify and treat gum pockets
- Bleeding gums
The aggressive periodontitis leads to the loss of bone tissue, which cannot be reversed. When the gums maintain their original height and the bone has resorbed along the root of the tooth, gum pockets develop. The pockets can be measured with a probe.
The distance from the bottom of the pocket, where the bone begins to be probed, to the edge of the gum is measured. Typically, bone resorption occurs first at the front teeth and the first molars. The bone resorption leads to tooth loosening and the associated loss of teeth. An additional X-ray image can provide an overview of the bone resorption.